Provider Demographics
NPI:1740247527
Name:SALEHBHAI, MANSOOR (MD)
Entity type:Individual
Prefix:
First Name:MANSOOR
Middle Name:
Last Name:SALEHBHAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1049 NORTH HOUSTON ROAD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093
Mailing Address - Country:US
Mailing Address - Phone:478-922-9001
Mailing Address - Fax:478-329-8619
Practice Address - Street 1:1049 NORTH HOUSTON ROAD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093
Practice Address - Country:US
Practice Address - Phone:478-922-9001
Practice Address - Fax:478-329-8619
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015890208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000080253HMedicaid
F19405Medicare UPIN
GA37BBFGTMedicare PIN